ST9301-CS010531 TEXAS DEPARTMENT OF LICENSING AND REGULATION
PROJECT REGISTRATION FORM
Code Review and Inspections / ARCHITECTURAL BARRIERS
P.O. Box 12157, Austin, Texas 78711 (512) 463-1668 (800) 803-9202 FAX (512)475-2871
Email Address: Architectural. Barriers @ license, state, tx. us Internet Address: www. license, state, tx. us
PLEASE PRINT OR TYPE PLEASE SEE IMPORTANT INSTRUCTIONS ON REVERSE SIDE BEFORE BEGINNING
1. Project Name
Coooell Sanely ]bake Road Paving. Drainage and Water System Improvements
2. Buildlng/Facllity Name
3. Location/Address Sandy Lake Road [City Coppell ZipCode75019 [County Dallas
4. Tenant (if other than owner) N/A Telephone Number
5, Mailing Address I City State I Zip Code
6. Contact Name Telephone Number
( )
7. Mailing Address [City State I Zip Code
8. Building/Facility Owner (NOT tenant) City of Coppell Telephone Number
;972 ~ 304-3679
9. Mailing Address I City State
I
Zip
Code
255
Parkwa:y
Bird
·] Coppell ~X
75019.
10. Con.ct Name Telephone Number
Ken Griffin~ P.E. (972) 304-3679
11. Mailing Address I City State I Zip Code
same as above
12. Design Firm Sver.dr?]~ I. nc. Telephone Number
13. Mailina Address Campr}e.L.L [;entre J.L · ; 21/+ 696-3433
8150 N.Central Exp.,Suite M-1150 C'tyDallas StataTX fi§~d~-1815
t4. Oesigner Information: F1Architect F]Engineer Fllnterior Designer F]Landscape Architect FlOther License No. (If applicable) Date Orawin~ls Sealed
Pdnt Name: Shannon L. Hebb 73677 7/19/00
15. Scheduledstart dateC°nstructi°n[mm/yy): l0 / 98mi 16. Scheduled Construction 02 / 02 17. Estimated Project
Completion Date (MM/YY): Construction Cost I~ 9,963,399.85
18. Description: Indicate type of work and bdefly describe scope.
nNew Construction nRenovation/Alteration nAdditions/Renovations FlAddition to Existing Bldg. nNew Construction/Renovation FlHistodc Preservation
Scope of work: __
19. Fl This project involves Public Funds, Public Land, Tax Abatement or is a State Lease I 20. State Lease No.
[] This proiect is Privately Funded, on Pdvate Land, for Private UseI (if applicable)
21. I hereby notify the Texas Department of Licensing and Regulation of the described project and of my intent to perform, or cause to be performed, all
services necessary to design said project in accordance with the provisions of Article 9102, Texas Civil Statutes. I certify that I am the registered design
professional with overall responsibility for the design of the project and whose seal is affixed to the drawing(s).
Signature of Architect, Engineer, Inledor Designer, or Landscape Architect Date Email Address
OR
I hereby notify the Texa/~Department of licensing and Regulation of my intent to comply with the provisions of Article 9/02, Texas Civil Statutes.
Signature of Building I:~m~ or Designated Agent Date Email Address
INDEPENDENTIMUNICIPAL CONTRACT PROVIDER USE ONLY Data construcUo, docun~ants wer~
ICP/MCP Project Number ICP/MCP Number. Plan Review submitted to the ICPIMCP for Plan Review
ICP/MCP Number: Inspection
I certify that the information pertaining to the submission date of the construction documents is true and
correct.
Signature of Independent/Municipal Contract Provider Date
DEPARTMENT USE ONLY Date Submitted to TDLR
AB Number Complaint Number
TDLR FORM All O05 02-2~-01